Provider Demographics
NPI:1396703963
Name:RUDISILL, JEAN ELAINE (CRNP)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:ELAINE
Last Name:RUDISILL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:JEAN
Other - Middle Name:BENTZEL
Other - Last Name:RUDISILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-2501
Mailing Address - Fax:717-461-7178
Practice Address - Street 1:13515 WOLFE RD STE C
Practice Address - Street 2:
Practice Address - City:NEW FREEDOM
Practice Address - State:PA
Practice Address - Zip Code:17349-9346
Practice Address - Country:US
Practice Address - Phone:717-812-2501
Practice Address - Fax:717-461-7178
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP003372C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1551674OtherGATEWAY-WMG
PA20019576OtherAMERIHEALTH MERCY
PA104975OtherJOHNS HOPKINS
PA3006201OtherCAPITAL BLUE CROSS-WMG
MD617962OtherCAREFIRST MD BCBS
PA500006997Medicare PIN
PA20019576OtherAMERIHEALTH MERCY
PA104975OtherJOHNS HOPKINS